Part of the TeachMe Series

Reversal of Loop Stoma

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Original Author(s): Ollie Jones
Last updated: February 19, 2019
Revisions: 6

Original Author(s): Ollie Jones
Last updated: February 19, 2019
Revisions: 6

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This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

Loop stomas are formed where faecal diversion is required to protect and defunction the down-stream bowel. Common reasons include a loop ileostomy as part of an anterior resection of the rectum (to reduce the morbidity if the anastomosis leaks) or a loop colostomy for severe peri-anal Crohn’s disease.

The advantage of a loop stoma is that they can be reversed without needing a full repeat laparotomy. The stoma is freed up by dissecting around the stoma to the peritoneum and then rejoined by either a side-side or stapled anastomosis.

The key point in the consent is to emphasise that this procedure is almost always done to improve quality of life rather than as a life-saving procedure.

Complications

Intraoperative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage As with any operation, there is a risk of bleeding; the risk in this operation is from the omental or peritoneal vessels.
Anaesthetic risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation

Early

Complication Description of Complication Potential Ways to Reduce Risk
Infection Superficial wound infection or intra-abdominal collections are both possible.  Chest infection is common, due to reduced lung expansion secondary to pain Peri-operative antibiotics will reduce the risk of wound infections.  Early mobilisation, optimal analgesia, and encouraging breathing exercises reduces the risk of lower respiratory tract infections
Anastomotic leak (~1-2%)  Leakage from the anastomosis may occur.  As with any anastomotic leak, this is potentially serious and frequently requires further surgery and re-formation of the stoma (which will then most likely be permanent).
Blood clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate.
Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery

Late

Complication Description of Complication Potential Ways to Reduce Risk
Incisional hernia As with any laparotomy, patients can develop incisional hernias through the old defect.